After anorexia and bulimia, the West has begun to be haunted by drunkorexia - self-imposed starvation or bingeing and purging, combined with alcohol abuse.
Drunkorexics are college-age binge drinkers, typically women, who starve all day to offset the calories in the alcohol they consume. The term is also associated with serious eating disorders, particularly bulimia, which often involve behavior like bingeing on food — and alcohol — and then purging.
Anorexics, because they severely restrict their calorie intake, tend to avoid alcohol. But some drink to calm down before eating or to ease the anxiety of having indulged in a meal. Others consume alcohol as their only sustenance. Still others use drugs like cocaine and methamphetamine to suppress their appetites.
"There are women who are afraid to put a grape in their mouth but have no problem drinking a beer," said Douglas Bunnell, the director of outpatient clinical services for the Renfrew Center, based in Philadelphia.
The center, like a small but growing number of eating-disorder and addiction-treatment facilities, most on the West Coast, offers a dual focus on substance abuse and eating disorders.
Dr. Bunnell, the past president of the National Eating Disorders Association, said the obsession with being skinny and the social acceptance of drinking and using drugs — along with the sense, lately, that among celebrities, checking into rehab is almost a given, if not downright chic — are partly to blame.
"Both disorders are behaviors that are glorified and reinforced," Dr. Bunnell said. "Binge drinking is almost cool and hip, and losing weight and being thin is a cultural imperative for young women in America. Mixing both is not surprising, and it has reached a tipping point in terms of public awareness."
Psychologists say that eating disorders, like other addictions, are often rooted in the need to numb emotional pain with substances or the rush provided by bingeing and purging. The disorders are often driven by childhood trauma like sexual abuse, neglect and other sources of mental anguish.
Manorexia is the male version of anorexia. Orthorexia is an obsession with what is perceived as healthy food — eliminating fats and preservatives, for example. But people with this condition can dangerously deprive themselves of needed nutrients.
Diabulimia refers to diabetics who avoid taking insulin, which can cause weight gain, in order to control their weight. Despite the name, the disorder does not typically involve purging.
Binge Eating Disorder refers to obsessive overeating, especially of foods high in salt and sugar, that does not involve excessive exercise or purging to compensate for the high caloric intake.
Many bulimics who drink use alcohol to vomit, experts on eating disorders say, because liquid is easier to purge. They also tend to vomit because they often drink on empty stomachs, reports the New York Times.
Trish, a nurse who lives in Ohio and works with cardiac patients, said she would starve herself through her 8- or 12-hour shifts, staring at the clock and fixating on when she could have her first drink. Drinking, she said, relaxed her when she had to eat in front of other people, a huge source of stress.
"The alcohol is probably what kept any weight on me," she said in an interview late last month at the Renfrew Center, which she entered on New Year's Eve for eight weeks of treatment.
"Drinking helped me be less anxious," she said. "It helped me be more of Trish. The two go together: If I drink more, I'm more into my eating disorder and vice versa."
Studies show that binge drinking and alcohol abuse are on the rise among women, who are also more prone than men to eating disorders.
About 25 to 33 percent of bulimics also struggle with alcohol or drugs, according to a study published last year in the journal Biological Psychiatry. Between 20 and 25 percent of anorexics have substance abuse problems, the study found.
A growing number of researchers are examining the psychological and neurological links between eating disorders and substance abuse: Does eating a chocolate bar, or bingeing and purging, stimulate the same pleasure centers in the brain as drugs or alcohol?
Suzette M. Evans, a professor of clinical neuroscience at Columbia, recently began a study of the connection between bulimia and substance abuse, a field she said had been neglected.
"People are finally beginning to realize that food can function in the same way as drugs and alcohol," Dr. Evans said.
As more patients seek treatment for both eating disorders and substance abuse, a complicated set of mixed messages can arise. The response to addiction is abstinence; but quitting food is not an option.
Trish left Renfrew on Feb. 22, after her second time in treatment there. She was determined, she said, to break her obsessions with weight, food and alcohol. Before she checked in, "I didn't even have the energy to laugh," she said. But as she prepared to go home, she had more hope than she has had in years.